In many operating room (O.R.) environments, the suture arrangements and management are handled primarily by a scrub nurse. Even though several guide lines for monitoring suture needles are followed, generally speaking the processes are imprecise and often lead to a situation where it is difficult or impossible to account for all the needles.
Sutures attached to their needles are kept on the general tray in the O.R. with a considerable amount of other equipment but without consistent arrangement or organization. Presently the usual approach is to place the sutures and attached needles in between folded towels after each has been removed from its packet. The needles are sometimes impaled into the towels to prevent them from being dislodged on the tray. Such impalement usually contributes to blunting the needle tips thus reducing their performance. The needles with their sutures are eventually handed to the surgeon who, after suturing, returns the needles which are finally impaled on a board. The packets from which the needles are taken are usually discarded.
Typically, the circulating nurse, who documents and brings the suture packets to the scrub nurse, is responsible for the needle count. At times the circulating nurse services more than one operating room or often has to leave the O.R. to obtain other equipment. The scrub nurse then cannot obtain additional sutures should they be required, because she cannot break her sterility. In this situation either the operation has to be halted until the circulating nurse returns or another member of the operating room personnel, usually the anesthetist, will obtain the sutures for the scrub nurse; the latter cannot note this in the chart. The scrub nurse is relied upon to tell the circulating nurse of the additional needles used; however, if the procedure is particularly absorbing, the message may not be given.
In an effort to minimize confusion on the scrub nurse's tray, only a relatively small selection of suture materials are provided. Accordingly, the tray is resupplied with sutures as they are required by the circulating nurse who is therefore depended upon to provide proper suture material and to tally the needles. The circulating nurse has other duties which may delay her supplying the suture material and thus delay the operation. Finally opened suture material is discarded at the end of surgery, as it has lost its sterility, and in a busy O.R., this cost is considerable.